What types of procedures require prior authorization?
All inpatient hospital admissions and certain procedures require prior authorization. Refer to the Prior Authorization List on www.triwest.com/provider or the West Region Benefit Lookup tool on the secure provider portal. • If a TRICARE Prime, TRICARE Prime Remote (TPR), or TRICARE Prime Remote for Active Duty Family Members (TPRADFM) patient (including active duty service members) is admitted following emergency care, does that admission require prior authorization? Hospitals must notify TriWest at 1-888-TRIWEST (1-888-874-9378) within 24 hours of an emergency admission to obtain authorization. This 24-hour notification also applies on weekends. Except in cases of true emergencies, TRICARE Prime and TPRADFM beneficiaries must also have approval from their primary care managers (PCMs) or the admission may be covered under the TRICARE Prime point-of-service (POS) option.
